Digital determinants of health: Futureproofing the health promotion community to navigate societal digital transformation

Society is experiencing a profound digital transformation; billions of people worldwide rely on digital platforms for social interaction, accessing services, shopping, entertainment, education and work. This has sparked growing calls to treat digital factors as a new category of determinants of health and well-being. These determinants, also known as the digital determinants of health,¹ encompass the direct and indirect pathways in which digital factors influence health, well-being and health equity.² This underscores the critical need for making our health promotion community adaptable to navigate the ever-evolving digital transformation of current and future society. This editorial piece highlights the critical roles of the health promotion community and the skills and knowledge they need to address the impacts of societal digital transformation.

With billions of users worldwide, social media plays a pivotal role as a digital determinant of health. The most popular platforms, including Facebook, YouTube, Instagram and TikTok, each have over a billion active users who spend several hours each day engaging with their content. While social media can provide valuable health and well-being information³ and promote healthy habits such as physical exercise, nutrition and facilitate social networking with friends and family, excessive exposure can be detrimental. It can affect sleep duration and quality, lead to social deprivation, opportunity costs, sedentary behaviour, eating disorders and exposure to harmful and harassing content, resulting in poor physical and mental health outcomes.⁴

The role of social media is particularly concerning for young people, who are at the forefront of digital transformation and who use these platforms significantly more often and for longer periods than older generations. Young people are especially vulnerable because they are exposed at a critical stage of brain development and identity formation.⁵ Negative social interactions and exposure to harmful social media content during this period can shape adolescent's developmental trajectories and have lasting impacts into adulthood. Over the last two decades, especially in high-income countries, there has been a significant shift from play-based childhoods to experiences heavily mediated by smartphones and social media platforms. These trends are largely due to the increasing prevalence of smartphones, which are now readily accessible to children from a very young age.⁶ In parallel, there has been a notable rise in mental health disorders among youth, including depression, anxiety, self-harm and suicide-related outcomes.⁷ While the role of smartphone use and social media in the alarming increase in mental health issues among young people remains under investigation, it is a growing area of interest for researchers and policymakers. The health promotion community must adapt to this rapid digital transformation fuelled by social media, particularly considering the unique vulnerabilities of young people to social media exposure and the associated physical and mental health risks.

Another critical aspect of societal digital transformation is the increasing exposure to online risks, such as data breaches, privacy issues, safety concerns, cybersecurity threats, excessive advertising, uncontrollable spending, and financial frauds and scams. The cumulative impact of these threats can breed scepticism and erode trust in institutions like the health care system and its professionals.⁸ Additionally, online fraud and scams can affect people's financial capacity, making them vulnerable to stress and anxiety, and compromising their ability to afford health services, thereby negatively influencing their health and well-being. This is particularly true for vulnerable groups such as the elderly, youth and minority communities, exacerbating health inequities. For instance, a recent survey in Australia showed a significant spike in social media scams targeting older people, with those aged over 65 recording the highest losses.⁹ Older adults affected by scams experienced not only financial loss but also significant impacts on their mental and physical well-being.¹⁰ The health promotion community need to be aware of the potential risks associated with being online and using digital technologies. They should understand how exposure to these online risks can be detrimental to health and well-being, with a particular focus on protecting the most vulnerable populations.

One of the key positive impacts of societal digital transformation is the advancement in digital health, which encompasses expanded access to digital health information, support seeking, facilitating health and well-being activities using technologies, and connection to health providers through telehealth. Digital technologies have enabled easier access to doctors and nurses, a feature that proved particularly useful during the COVID-19 pandemic.³ Digital health research has led to the development of apps and wearable technologies that promote health and well-being, track health records, and monitor various health metrics.⁶ For example, numerous mobile apps help pregnant women monitor physical activity patterns, nutrition, heart rates and their child's growth.¹¹ With these new technologies and the ongoing digital transformation, society is increasingly inclined to seek digital health services. Future research and development will likely focus on creating more digital products, apps and services to navigate this evolving landscape. Health promotion professionals should familiarise themselves with new digital health technologies and maximise the potential of these innovations while recognising the changing needs of society.

Artificial intelligence (AI) has become a key driver of rapid digital transformation. The collection of vast amounts of digital data has significantly enhanced AI's influence and adoption, leading to critical transformations in health-related services and products. AI is now increasingly integrated into our health care system, particularly in clinical practice for diagnosing and treating diseases, patient engagement, medication adherence, disease surveillance and health systems management. While AI presents powerful opportunities to accelerate digital health transformation, concerns regarding data security, ethics, safety and potential job automation, including within the health care workforce,¹² should be addressed. Algorithmic decision-making processes used in AI rely on the data they are trained on. If these data reflect or amplify existing societal biases, it can lead to discriminatory outcomes in health care delivery. For instance, biased algorithms might underdiagnose certain conditions in minority populations or recommend less effective treatment options. It is essential for the health promotion community to recognise AI's emerging and expanding role in health care, disease prevention, public health and health promotion, and address the concerns associated with its application.

The digital revolution has irrevocably transformed our lives, and the health promotion community must rise to the challenge by equipping itself with the necessary skills, knowledge and tools required to navigate this evolving landscape. Professionals must cultivate robust digital literacy, including an ability to assess how to use and evaluate digital health resources and tools effectively. The knowledge of data privacy, cybersecurity and ethical considerations in digital health is also crucial to protect and empower the communities they serve. Additionally, skills in digital communication and online engagement are essential for reaching and influencing a broad audience through social media and other digital platforms. Familiarity with emerging technologies like AI can also enhance the design and safe implementation of innovative health promotion strategies. Continuous professional development and training in these areas will be necessary to keep pace with the rapid technological advancements and to ensure that the health promotion community can leverage these tools to improve health outcomes and equity.

Policies and regulations are needed to match the ever-increasing societal demand and rapid digital transformation, assisting our health and social systems in navigating this swift change. Ongoing policy proposals in South Australia and Florida, to restrict smartphone and social media access for young people, are excellent examples of such policy reforms. When such reforms are implemented, it is inevitable that social media companies will respond—similar to how Big Tobacco, Big Alcohol and Big Food industries have responded to control initiatives for tobacco, alcohol and unhealthy food, as well as ongoing vape control efforts. These industries have used tactics such as undermining and discrediting evidence, attacking organisations and individuals, challenging policy positions, promoting ‘safer’ alternative products and persuading health care systems to support their products (e.g., incentivising pharmacies to sell more vaping products). Social media companies are likely to employ similar strategies, particularly against significant policy reforms. It is crucial to remember that these companies have the upper hand—they control major media platforms that reach billions, granting them unparalleled reach and access to vast troves of data that can be leveraged to shape public discourse and distort health narratives. The potential impact of social media on public health behaviour could even surpass the historical influence of powerful industries like Big Tobacco and Big Alcohol. In light of this power imbalance, the health promotion community must be prepared and well-equipped to address these challenges.

The authors have no conflicts of interest.